Wilkie D J, Keefe F J
Department of Physiological Nursing, University of Washington, Seattle 98195.
Clin J Pain. 1991 Dec;7(4):292-9. doi: 10.1097/00002508-199112000-00007.
Previous findings in patients with nonmalignant pain indicate a relationship between pain coping strategies and psychological factors. Although coping strategies have been explored in patients with cancer pain, relationships with such factors have not been reported. We wished to examine relationships between selected pain and psychological variables and the use of pain coping strategies. Forty-five patients with pain related to lung cancer indicated how they expressed their pain to others and completed the McGill-Melzack Pain Questionnaire (MPQ), State-Trait Anxiety Inventory, Visual Analogue Scale of pain intensity, and the Coping Strategies Questionnaire (CSQ). Forty-two percent of the patients reported that they tried not to let others know they had pain, and 40% indicated they told others when they had pain. Preferences for not telling others was associated with more frequent pain coping attempts for all CSQ subscales but those of catastrophizing and reinterpreting pain sensation. State anxiety demonstrated positive correlation with catastrophizing coping strategies (r = 0.48) and negative correlation with ability to control (r = -0.50) and decrease (r = -0.50) pain. The number of pain sites was correlated with coping self-statements (r = 0.34). Pain intensity and state anxiety demonstrated similar relationships. Pain quality as measured with the MPQ demonstrated moderately strong correlation with diverting attention, praying and hoping, catastrophizing, and increased activity. Interventions aimed at reinforcing or expanding a patient's pain coping repertoire should be developed with consideration given to the patient's anxiety level, pain intensity, pain quality, and pain expression preference.
先前针对非恶性疼痛患者的研究结果表明，疼痛应对策略与心理因素之间存在关联。尽管已经对癌症疼痛患者的应对策略进行了探索，但尚未报告其与这些因素的关系。我们希望研究选定的疼痛和心理变量与疼痛应对策略的使用之间的关系。45名肺癌相关疼痛患者说明了他们如何向他人表达疼痛，并完成了麦吉尔-梅尔扎克疼痛问卷（MPQ）、状态-特质焦虑量表、疼痛强度视觉模拟量表和应对策略问卷（CSQ）。42%的患者报告说他们尽量不让别人知道自己疼痛，40%的患者表示疼痛时会告诉别人。不告诉别人的偏好与所有CSQ子量表（除了灾难化和重新诠释疼痛感觉的子量表）更频繁的疼痛应对尝试相关。状态焦虑与灾难化应对策略呈正相关（r = 0.48），与控制疼痛的能力呈负相关（r = -0.50）以及减轻疼痛的能力呈负相关（r = -0.50）。疼痛部位的数量与应对自我陈述相关（r = 0.34）。疼痛强度和状态焦虑表现出相似的关系。用MPQ测量的疼痛性质与转移注意力、祈祷和希望、灾难化以及增加活动呈中度强相关。旨在加强或扩展患者疼痛应对方法的干预措施应在考虑患者焦虑水平、疼痛强度、疼痛性质和疼痛表达偏好的基础上制定。
